Bariatric Inpatient Preparation Group

1
Bariatric Inpatient Preparation Group

• Specialist Bariatric Surgery Dietitians
• Laura Carstairs
• Cleverly Fong
• Bariatric Nurse Specialist
• Tamara Ramkalawan
• Cecilia Jones
• Bariatric physiotherapist
• Al Myers

2
Objectives

• Inpatient experience
• Length of stay operation
• Medications
• Pregnancy
• Before surgery and after diets
• Breathing circulation exercises
• Importance of early post-op mobility
• Introduction to physical activities

3
The surgery

• Usually done as keyhole surgery
• Quicker recovery time
• Length of stay in hospital
• 1 to 2 days for Gastric Banding, surgery time
  1-2hrs
• 3 to 4 days for the other surgeries, surgery
  time 1.5 4hrs

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Day of surgery

• Omit diabetes tablets, blood pressure tablets,
  insulin, and other regular tablets morning of
  surgery unless instructed specifically to do
  otherwise
• Warfarin and aspirin to follow your
  consultants instruction
• Bring all meds and CPAP
• Bring personal clothing and toiletries for use on
  ward
• Arrange transport to come into and discharge from
  hospital
• Walk to theatre and onto the operating table

5
Ward experience

• Surgical ward after recovery
• IV Fluids, Flowtron and TEDS, Nursed upright,
  Oxygen therapy, Drains
• Regular observations
• Sips of water to clear fluids
• MRSA screening
• Nebulizers, CPAP to start 48hrs post surgery
• Clexane (you may get some bruising) and early
  mobilisation

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What will you feel like after surgery?

• Pain ( wind or bloating) painkiller will be
  given
• Nausea and vomiting anti-sickness will be given

7
When to alert staff

• Short of breath, anxiety and chest or calf pain
• Severe onset of abdominal pain
• Racing heart beat
• Vomiting
• Wounds bleeding

8
Discharge

• Medication Clexane, Fastabs, Multivits, Adcal,
  painkillers, laxatives (no whole tablets, liquid,
  soluble, chewable or crushed meds using a pill
  crusher or spoons for 4 wks post surgery)
• G.P.- get repeat prescriptions return sharps
  bin
• Practice nurse wound dressings, Blood sugar and
  BP to be checked regularly
• Appointments with nurse, dietitian and surgeon.
  Band fills 4-6 wks post op
• Contact team if any problems

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Pregnancy

• Weight loss can increase fertility
• Pregnancy is not advised during the first 18
  months after surgery as it can be very risky for
  both mother and baby.
• - Potential for maternal and fetal
  malnutrition
• - Gestational diabetes
• - Preeclampsia ( High blood pressure in
  pregnancy)
• - More likely to need cesarean delivery
• - Blood clots after giving birth
• - Increased blood loss during delivery
• - Increased risk of miscarriage, pre-term
  birth, stillbirth
• - Increased risks of congenital anomalies,
  growth abnormalities, etc.

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Pre op liver shrinkage diet

• Follow for 2-4 weeks pre surgery
• 4 weeks if BMI over 50
• 3 options
• Food based diet
• Milk diet
• Slimfast diet
• All 1000kcal, low carbohydrate
• Caution with diabetic control
• Follow one diet only- do not mix and match

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Post surgery liquids in hospital

• Water
• Tea/coffee
• Milk
• No added sugar squash
• Clear soup
• Build up soup tomato flavour (ask the staff!)
• You should not be having yoghurt, jelly, ice
  cream or liquids with bits or lumps at this stage

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Post-surgery Stage Diet
Stage 1 Liquid Diet 2 weeks Except after Sleeve Gastrectomy 3 weeks
Stage 2 Puree Diet 2 weeks
Stage 3 Soft Textured Diet 2 weeks
Stage 4 Normal Diet Long term
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Physiotherapy in the Ward

• You will be seen the day after your surgery.
• Your respiratory system and movement will be
  checked.
• You will be advised on breathing and circulation
  exercises.
• You will be encouraged to sit out of bed as much
  as possible and to walk around the ward lots.

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Why is early mobility important?

• Early mobility restores normality to your bodys
  systems by
• Speeding up your recovery from the anaesthetic.
• Reducing your risk of developing blood clots.
• Making the lungs work more effectively and
  reducing the risk of chest infections.
• Moves trapped wind from your abdomen.

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Can I reduce the risk of blood clots?

• Early mobility!
• Practice circulatory exercises of your ankles
  point the feet down all the way then pull up and
  perform clockwise/anti-clockwise circles.
• Repeat roughly 5 times in each direction hourly
  throughout the day.
• Remember spelling the alphabet with your toes.

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Could I get a chest infection after the operation?

• The anaesthetic used in the operation reduces
  lung function.
• You can feel pain in your abdomen - making deep
  breathing and coughing painful.
• This can cause mucus/phlegm to gather in your
  lungs and can cause a chest infection.
• If you are a smoker, you are already at a higher
  risk of chest infections as the lungs tend to
  contain more mucus.

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How can I reduce the risk of chest infections?

• Early mobilisation!
• Sitting out of bed (make the lungs more upright).
• If you smoke, please look to stopping
• contact the NHS Stop Smoking Helpline on 0800
  022 4 332 or access information online at
  smokefree.nhs.uk.

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How can I reduce the risk of chest infections?
Contd.

• Tell ward staff if your pain stops you doing
  breathing exercises, perform an effective cough
  or mobilise.
• Support your abdomen with your hands, a towel or
  pillow when coughing to reduce pain.
• Practice breathing exercises twice an hour to
  keep the chest as clear as you can - less phlegm,
  less risk of infection

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Breathing exercises?

• The Active Cycle of Breathing Technique (ACBT)
  exercises.
• To start-get comfortable sit up in bed or
  sitting upright in a chair.
• Breath in through your nose and out through your
  mouth if possible.

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Lets Practice The Cycle
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What Breathing Exercises can I do? Contd.

• 1. Breathing Control Normal, relaxed
  breathing as you would do, do 6-8 breaths.
• 2. Deep Breaths Breathe in slowly and
  deeply, breathe out without forcing it, repeat 3
  or 4 times.
• The Huff Take a medium sized breath in, breathe
  out forcefully for a short time, keep your mouth
  open and use your stomach muscles. Imagine you
  are steaming up a mirror with your breath.
• Practice the cycle every hour-stop if you feel
  your cough the dry and unproductive.

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Physical Activity

• In the ward we will discuss
• benefits of physical activity
• the government recommendations
• check your current physical activity levels
• help set shared goals
• exercise initiatives local to you
• Regular physical activity is essential to the
  lifestyle change required to get the most from
  this procedure in the long-term
• General rules for activity after surgery - avoid
  heavy lifting until you feel comfortable and
  swimming until your wounds have healed.
• If you drive, contact your insurance provider to
  ensure they are happy with coverage also make
  sure you can comfortably perform an emergency
  stop.

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The PACE Class

• If you can get to the Hospital and commit to the
  twelve weekly classes you can join the Physical
  Activity Circuit and Education (PACE) class.
• Exclusively for patients who have had bariatric
  surgery at the Homerton University Hospital.
• You will take part in education sessions combined
  with physical activity circuits.
• Its aim is to introduce, support and motivate for
  increasing your physical activity levels.
• Classes run every Tuesday evening from 6.30-8pm
  and Wednesday afternoons from 3pm-4.30pm.
• The classes last for 12 weeks.

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Questions?

• Thanks for listening and good luck!
• Any questions for the team? ?
• YOU ALL NEED TO ATTEND PRE ADMISSION IN THE
  SURGICAL CENTRE TODAY